Trauma of Hospitalization Is Common in Medical Inpatients But Is Not Associated with Post-Discharge Outcomes

BackgroundTrauma of hospitalization is characterized by patient-reported disturbances in sleep, mobility, nutrition, and/or mood and one study suggested it was associated with more 30-day readmissions.ObjectiveTo define the trauma of hospitalization in medical inpatients and determine whether higher rates of disturbance correlate with adverse post-discharge outcomes.DesignA prospective cohort study was conducted between June 2018 and August 2019 with patients reporting disturbances in sleep, mobility, nutrition, and/or mood. High trauma of hospitalization was defined as disturbance in 3 or 4 domains.ParticipantsGeneral medicine inpatients at an academic hospital in Edmonton, Canada.Main Measures7-day, 30-day, and 90-day rates of death, unplanned hospital readmission, or emergency department (ED) visit.Key ResultsOf 299 patients (mean age 65.9 years, 47.8% female, mean Charlson score 3.6, and mean length of stay 8.2 days), 260 (87.0%) reported disturbance in at least one domain (most commonly nutrition or mobility) during their hospitalization, 179 (59.9%) reported disturbances in multiple domains, and 87 (29.1%) met the criteria for high trauma of hospitalization. Patients who reported a high trauma of hospitalization did not differ from those reporting less hospitalization disturbances in terms of demographics, burden of comorbidities, or length of stay, but did report higher rates of pre-hospital disturbances in sleep (32.3% vs. 14.4%, p = 0.03), nutrition (77.4% vs. 54.4%, p = 0.02), and mood (41.9% vs. 13.3%, p = 0.0007). High trauma of hospitalization was not significantly associated with death, readmission, or ED visit at 7 days (12.6% vs. 11.3%, aOR 1.13 95% CI 0.52–2.46]), 30 days (31.0% vs. 32.1%, aOR 1.03 95% CI 0.59–1.79]), or 90 days (52.9% vs. 50.9%, aOR 1.16 95% CI 0.69–1.94]) after discharge.ConclusionsIn-hospital disturbances in sleep, mobility, nutrition, and mood are common in medical inpatients but were not associated with post-discharge outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06427-4.KEY WORDS: hospitalization, patient experiences, post-discharge outcomes

While it has long been known that hospitalization exposes patients to risk of iatrogenic illnesses, nosocomial infections, and deconditioning, there is emerging evidence that patient subjective experiences during their hospitalization may also influence their post-discharge outcomes.^1–3 Detsky and Krumholz described the stressful and depersonalizing effects of the hospital environment as the “trauma of hospitalization” and hypothesized that the cumulative effect of hospital-related disturbances in sleep, mobility, nutrition, and mood (even when not recognized by their care team) may cause physiologic disruptions that worsen patient outcomes, potentially increasing their probability of unplanned readmissions or emergency department (ED) visits.^4–6A recently published prospective cohort study used a 10-item patient-reported “in-hospital disturbance survey” (see Box 1) to examine the trauma of hospitalization in medical inpatients and post-discharge outcomes.⁷ The survey evaluated the 4 domains of sleep, nutrition, mobility, and mood: the 29.5% of patients who reported disturbance in 3 or 4 domains in hospital were considered to have high trauma of hospitalization and they exhibited a substantial and statistically significant increase in risk of 30-day readmission or ED visit (37.7% vs. 21.9% in those patients who reported lower trauma of hospitalization, adjusted Odds Ratio 2.52, 95% CI 1.24 to 5.17).⁷ While this result highlighted a potentially important novel opportunity for future interventions to improve both patient experience and clinical outcomes, their findings must be validated in other settings. Thus, we designed this study to examine the trauma of hospitalization in medical inpatients and to explore whether high scores on the in-hospital disturbance survey are associated with higher rates of readmissions or repeat ED visits or death at 7 days (our primary outcome), 30 days, and 3 months in a different geographic setting.Box 1 Disturbance survey (adapted from Rawal et al.⁷)